Childhood Foot Pain: Common Foot and Knee Complaints in Children
Your child's well-being is of utmost importance. If they complain of pain or have difficulty walking due to sore or tired legs, this could indicate underlying issues with their feet or legs. At Laufgsund, we understand this and are here to help.
In this blog, you'll find an overview of possible misalignments and the most common foot and knee complaints in children.
The most common misalignments: bow legs, knock knees, and pediatric flat feet
Bow legs in newborns and knock knees in toddlers are completely normal.
In newborns, bow legs are entirely typical, as the baby assumes a crouched position in the womb due to limited space. Additionally, the wide gait that comes with bow legs provides stability and confidence for early walkers.
From the newborn's bow-legged position, the typical knock-knees of toddlers develop. In most children, leg alignment naturally normalizes by around age 6.
Parents therefore shouldn’t worry if their baby has bow legs, as the leg alignment usually corrects itself over the course of natural development. However, if there are noticeable differences between the left and right side, or if the child has discomfort or difficulty walking, it’s advisable to consult a professional.
In the second year of life, a knock-kneed alignment may develop, often lasting until around age five. Children in this age group also frequently have flat feet, which is part of the normal developmental process. Through play and exploration, they train their muscles and gradually develop more confidence in walking."
Pronated/flat feet or flexible flatfoot:
Pronated or flat feet are also completely normal in toddlers, as this foot position often corresponds with a knock-knee alignment. Feet appear flat because there is still a thick layer of fat in the midfoot area, making the feet look flat. As the child begins to walk independently, this so-called 'baby fat' decreases, and the foot muscles develop.
Sometimes, however, the arch of the foot is so low that it partially or completely rests on the ground. Because the foot tilts inward, this can affect the posture of the rest of the body, potentially leading to various discomforts.
A flexible flatfoot is generally caused by weak ligaments. Under pressure, the arch of the foot lowers toward the ground. When lifting the foot or standing on tiptoes, the arch naturally corrects itself.
In most cases, pronated/flat feet naturally correct themselves by around 8 to 10 years of age.
My child complains of tired legs
Issues with knock knees or bow legs
If your child’s feet still turn inward after the age of seven, and they complain of tired or aching legs, frequently trip, or are reluctant to walk, you may want to consider an assessment with us.
Due to the misalignment of the legs, there is increased tension on the tendons and muscles on the inner side of the feet and knees, which can lead to these symptoms. Children 6 to 7 years of age, with knock knees, combined with a significant foot misalignment, such as flat feet, or pain can benefit from targeted treatment with us.
During the assessment, we analyze the alignment of the feet, knees, and hips, as well as the child’s gait. If knock knees or bow legs are caused or worsened by incorrect foot positioning, custom orthotic insoles can help improve weight distribution on the joints of the lower extremities. Additionally, muscle-strengthening exercises for knock knees can support treatment. Regular follow-up visits ensure that the correction of foot and leg alignment is continuously monitored.
The Most Common Knee Complaint in Children: Osgood-Schlatter
What is Osgood-Schlatter?
Osgood-Schlatter is a painful overuse injury or irritation of one of the growth plates in the knee, located at the front below the knee, where the tendon attaches to the shinbone. This condition most often affects boys aged 10 to 15 and girls aged 8 to 13. Osgood-Schlatter is especially common in active children who frequently run or jump.
How Can Osgood-Schlatter Develop?
In sports like basketball, volleyball, and track and field, where children jump and run a lot, the growth plates can become overloaded, causing pain. Pain and swelling may also result from abnormal foot positioning, such as flat feet or high arches. Additionally, trauma or injury, excess weight, weak or tight muscles, or excessive strain can contribute to these complaints.
What Symptoms Can Occur with Osgood-Schlatter?
- The child often feels pain just below the knee, where the patellar tendon attaches to the shinbone. The pain can occur in one or both knees.
- There is often swelling or a bump at the painful spot.
- Pressure on the painful area, such as kneeling, can also cause pain.
- When the pain arises during training, it often subsides in the hours following the activity.
What Can Be Done About Osgood-Schlatter?
To examine the tendon attachment, targeted pressure is applied to the affected area. Additionally, we check the functionality and flexibility of the thigh muscles. Often, the child’s age and the location of the pain are enough to make a diagnosis, but in some cases, an X-ray or ultrasound may be needed to confirm it.
We also conduct a gait analysis to identify any potential misalignments that could be worsening the symptoms.
Once the child is fully grown and the growth plate closes, the pain usually resolves on its own.
In general, the child ddoes not need to stop training, but with intense pain it is better to take more rest or reduce training hours. Sometimes, icing the painful area, stretching, and/or strengthening the thigh muscles can also be beneficial.
Custom orthotics, combined with footwear guidance, can help reduce tension on the patellar tendon at the kneecap, thereby relieving knee pain. Treatment is needed until the growth plate has fully matured.
"90% of patients can be successfully treated conservatively."
What Are the Most Common Foot and Knee Complaints in Children?
Growing Pains: Nighttime Pain
When children feel pain at night, it is often due to what’s known as growing pains. Growing pains are uncomfortable but not a cause for concern. They are common in children between approximately 2 and 12 years old. During or after a growth spurt, muscles may be shorter than bones, as bones tend to grow faster than muscles. This can lead to temporary muscle tightness, causing discomfort.
How Can You Recognize Growing Pains in Your Child?
Growing pains mainly occur in the shins, calves, the front of the thighs, behind the knees, and sometimes in the arms. Typically, the pain arises in the evening or at night and usually disappears by morning. The pain can be intense but may also be persistent and bothersome. Growing pains tend to happen in episodes. A child may go for a while without any pain, followed by a period with frequent growing pains.
How to Help Your Child with Growing Pains:
When growing pains occur, it can be helpful to reassure your child. If they have trouble falling asleep, a mild pain reliever like paracetamol may help. Regular stretching and massaging of the calf and thigh muscles can also alleviate discomfort.
Magnesium supplements can sometimes help reduce growing pains. There are various forms of magnesium suitable for children; it’s best to consult your pediatrician or pharmacist for advice.
If the pain is very intense, interferes with your child’s daily activities, or is accompanied by swelling, redness, or fever, it’s important to see a doctor to rule out other possible causes.
Heel Pain in Children: Sever’s Disease as a Common Cause
Does your child experience pain in the lower legs or heels, especially after physical activity or even at rest? A common cause of such discomfort is Sever’s Disease, the most frequent type of heel pain in children. Sever’s Disease typically affects active children between the ages of 7 and 12. The growth plate at the back of the heel bone remains open until around age 12, making the heel particularly vulnerable as it grows in multiple directions. Overuse can easily make this growth plate a weak point, leading to pain.
Heel pain in children should be taken seriously, especially if it occurs frequently after sports.
What Symptoms Can Occur with Sever’s Disease?
- Persistent or sharp pain at the back or underside of the heel
- May affect one or both heels simultaneously
- Pain during and after training, running, jumping, and/or pushing off
- Pain often subsides with rest
- Occasionally, a small swelling may develop where the Achilles tendon attaches to the heel bone
- Some children may walk on their tiptoes to reduce heel pressure and prevent pain
What Are Possible Causes of Sever’s Disease?
Sever’s Disease commonly occurs in active children who engage in high-impact activities like running, jumping, or sports such as basketball, tennis, hockey, or soccer. Highly active children often develop strong calf muscles that attach to the heel bone via the Achilles tendon. When these muscles are tight or overused, the strain on the heel bone significantly increases. If your child’s feet tend to tilt inward, this can increase the tension on the Achilles tendon and heel bone even more. Excess weight can also be a contributing factor, as the extra load puts more stress on the heel.
Treatment for Sever’s Disease: Rest, Orthotics, and Proper Footwear
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Treatment for Sever’s Disease involves reducing heel stress during running and sports. In general, your child does not need to stop sports entirely, but with severe pain, rest is advised, such as cutting back on training frequency.
Custom orthotics can help relieve the tension from the Achilles tendon on the heel and correct any foot misalignments. In most cases, orthotics need to be worn until the growth plate is fully mature and able to bear more load. Shoes with a thicker, cushioned sole can also help alleviate discomfort.
When Flat Feet (Pes Planus) in Children Require Attention
While flat feet (pes planus) are normal in young children up to a certain age, issues may arise if the arch collapses so much that it partially or fully touches the ground. This can affect posture, as the foot tilts inward, which places increased strain on the tendons and muscles of the inner foot and knee.
When these effects appear, flat feet should be examined more closely and treated if necessary to prevent further complications.
What Symptoms Can Occur with Flat Feet?
- Development of blisters on the inside of the feet
- Pain in the feet and/or legs
- Reluctance to walk; the child may ask to be carried or prefer to ride in a stroller
- Abnormal, awkward, or limping gait
- Quick fatigue and cramps in the lower legs
- Frequent tripping and stumbling
- Knock knees (X-legs)
- Rapid wear on the inside of shoes
When is an Evaluation at Laufgsund for Flat Feet Advisable?
An evaluation is especially beneficial if any of the listed symptoms are present. We analyze the causes of these complaints and can take targeted measures. With custom orthotics, we can help improve alignment. Additionally, simple exercises can strengthen the muscles, and we can provide guidance on appropriate footwear. We also collaborate with physiotherapists to ensure a comprehensive treatment approach to alleviate discomfort. Regular follow-up exams help monitor and sustain the correction of foot and leg alignment over time.
Regular Check-ups for Children
After the initial examination, we gain a clear understanding of the child's condition, gait, and symptoms. If needed, a treatment plan is created and discussed with the child and parents, with regular collaboration with the physiotherapist. The child’s foot is complex and still in a developmental phase. Receiving custom orthotics does not necessarily mean your child will need them for life. Orthotics can also be used preventatively to influence foot alignment as the child grows.
Your child will learn exercises to strengthen muscles and improve stability. We also offer toe orthotics and footwear consultations as needed. An initial follow-up takes place after six to eight weeks to assess how symptoms may have progressed. To closely monitor foot development, regular check-ups are conducted. For orthotics, they are checked approximately every six months and adjusted as needed.
Your child will learn exercises to strengthen muscles and improve stability. We also offer toe orthotics and footwear consultations as needed. An initial follow-up takes place after six to eight weeks to assess how symptoms may have progressed. To closely monitor foot development, regular check-ups are conducted. For orthotics, they are checked approximately every six months and adjusted as needed.